Utilizing Teleconsultation Models to Address Mental/Behavioral Health Care

General Strategies on Partnerships between PMHCA Programs and Pediatric Practices

• Hold real time, rapid telephone consultations between PMHCA programs and practices. For example, one PMHCA program offers telephone responses within 30 minutes and email responses within 24 business hours to pediatric practices.
• Hold one-time face-to-face consultations with PCPs within 2 weeks to clarify any next steps following a phone consultation.
• Implement a statewide telecommunications system with PMHCA program hubs that follow the same process to ensure consistent experiences.
• Provide written consultation notes to PCPs with practical strategies related to addressing mental/behavioral health concerns.
• Recruit Primary Care Champs to help increase collaboration between practices and PMHCA programs.
• Work with PMHCA programs on implementing mental/behavioral health screening into practice flow, electronic medical records, and coding/billing.
• Expand mental/behavioral health screenings in pediatric practices to include social determinants of health, caregiver depression and early childhood mental health concerns.
• Work with a licensed clinician from a PMHCA program in development of a mental/behavioral health plan with families and with locating appropriate referrals.
• Hold group educational experiences with pediatric practices, such as Continuing Medical Education (CME) lectures, webinars, and Extension for Community Healthcare Outcomes (ECHO) sessions.
• Create or utilize existing web-based educational modules on common mental/behavioral pediatric diagnoses and include information on diagnosis, screening, medication management and best practices.
• Hold office hours with the PMHCA program consultation team to discuss concerns related to general topics or specific patients.
• Hold office lunch and learns led by PMHCA program consultation teams.
• Offer training information for PCPs on PMHCA program websites and within monthly newsletters.
• Hold “Provider Cafes” to support PCPs during the pandemic.
• Leverage telehealth consultations to support youth at risk for suicide. For additional information and support, please view the following resource: Blueprint for Youth Suicide Prevention.

Increasing Access to Mental/Behavioral Health Care in Rural Communities

One PMHCA program, which has clinics throughout a rural and frontier geographic region, has implemented strategies to increase access to mental/behavioral health services. Strategies include:

• Utilize a site coordinator located at the clinics to help patients and families/caregivers without consistent internet access schedule and attend appointments.
• Offer tele-behavioral health appointments to patients and families/caregivers from home.
• Utilize a hub and spoke model with clinicians who have expertise in pediatric mental/behavioral health centrally located and co-located in clinics to increase access to care to rural communities.
• Employ telemedicine coordinators who travel across the clinic locations to assist patients and practices before, during and after the tele-behavioral health appointments, which limits the impact on primary care workflows.
• Through the PMHCA program, offer training to practices related to motivational interviewing and patient self-management, best practices for treating mental/behavioral health conditions, and alternative approaches to integrating mental/behavioral health.
• Offer monthly resilience huddles with rural health care workers to promote resiliency among staff.

Preliminary Outcomes: This practice has shown favorable outcomes among patients and families/caregivers as measured by self-assessments of individual mental health. Patients who completed at least 2 encounters experienced more than 20% improvement in anxiety symptoms and 14% improvement in depressive symptoms.

^{The tips and strategies outlined in this promising practice were provided by the University of Kansas Medical Center.}

Strategies for Supporting Families/Caregivers

• Offer handouts related to mental/behavioral health for families/caregivers on PMHCA program websites.
• Hold scheduled telehealth consultations directly with families/caregivers from their homes.
• Support families who may not have reliable broadband/internet access at home through the following strategies:
  • Invite families/caregivers into pediatric offices for telehealth assessment with PMHCA program.
  • Utilize a site coordinator located within a clinic to support families/caregivers with teleconsultation appointments.
  • Partner with school districts to provide tele-behavioral health services for patients without internet access; utilize telehealth school site coordinators to help families to continue their telehealth appointments at school in a safe way and help coordinating care.
• Integrate input from other members of the child’s team into care plans (school, therapist, specialists, etc).
• Create pediatric crisis and family support plans to be used for at-home appointments with an emphasis on coordination with local resources.

• Build relationships between PMHCA programs and perinatal psychiatry access programs, to support children from birth and beyond.

• Connect families/caregivers with additional support opportunities. For more information, please see the National Alliance on Mental Illness (NAMI) Family Support Group.

Strategies for Sustainability of PMHCA Partnerships

• Work with AAP chapters on creation, implementation and evaluation of PMHCA programs.   
• Collaborate with AAP chapters on trainings for pediatric practices.   
• Educate potential partners to create awareness about the importance of PMHCA programs.    

For additional information on how AAP chapters can partner with PMHCA programs, view the following tip sheet: 

• Tips for AAP Chapters: Increasing Access to Behavioral Health Care via Telehealth by Partnering with Pediatric Mental Health Care Access Programs 

^{The tips and strategies outlined in this web page were provided by Anonymous Contributors, Texas Child Mental Health Care Consortium, Children’s Hospital of The King’s Daughters, Consortium Group Project Teach, Massachusetts Child Psychiatry Access Program, Wisconsin Child Psychiatry Consultation Program, Missouri Child Psychiatry Access Project, Oregon Psychiatric Access Line, Project TEACH NY, KSKidsMap, Michigan Child Collaborative Care Program (MC3), University of Michigan and Michigan Department of Health and Human Services, Virginia Mental Health Access Program.  We are grateful to the National Network of Child Psychiatry Access Programs (NNCPAP) for their partnership in collecting these tips and strategies.}